Aspen Valley Hospital officials say they are concerned yet confident the organization is financially well positioned as they brace for a sharp drop in revenue this year after two strong months to start 2020.

AVH executives told their board of directors last week the suspension of elective surgeries, a plummet in orthopedic business because of early ski-area closures, and a host of other COVID-19-related factors have them cautious about the hospital’s bottom line for the rest of 2020.

CEO David Ressler and Chief Financial Officer Ginette Sebenaler also said they are eying ways to preserve as much as $11.3 million in cash through non-revenue sources such as grants and donations, as well as cutting capital expenditures, for example. Their comments came when the board held its monthly meeting over the Zoom video platform April 13.

AVH has 25 beds and is federally designated as a “critical access hospital” due to its remoteness. And while Gov. Jared Polis exempted critical access hospitals from his suspension of non-essential surgeries in Colorado through an order he issued in mid-March, around the same time AVH said it was postponing elective surgeries until March 30, citing “recommendations from the surgeon general of the United States and the American College of Surgeons.”

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That suspension is now in effect until at least April 30, Ressler said in an interview Saturday.

Fallout from the pandemic has forced the hospital to sever the equivalent of three seasonal full-time positions from its payroll, but it doesn’t have designs to make further staff cuts or trim pay based on its most recent financial projections.

“We have always had this philosophy of protecting the core, which is full-time and part-time staff and avoiding to have to reduce staff or the workforce,” Ressler told the board.

Hospital executives also expect the organization’s days cash in hand — a barometer of sorts for an organization’s fiscal health — to drop significantly this year from what is currently 239 days to as low as 107 by the end of the year.

If the hospital opts for the cash-preservation approach that figure would stand at 141, based on projections Sebenaler gave the board. That’s a decision the board must make in the future.

Days of cash in hand is a metric that represents how many days a business can stay operational by paying its expenses with its existing funds.

The AVH board has held a minimum 180-day standard for that metric, but its members acknowledged last week that its rainy day fund is ready for use. Ressler, quoting what Sebenaler recently relayed to him, told the board “it’s pouring now.”

On Saturday, Ressler said while the hospital feels somewhat comfortable in terms of its fiscal health, there are no guarantees because of the uncertainty of what the pandemic will bring next. He equated the hospital’s financial situation to a family that taps into its savings when the money runs dry.

“We believe there are sunnier days ahead when we will be able to recover, but having said that, like any family, when you start spending your savings you become nervous and you don’t fully know what the future holds,” he said. “And in our case, we don’t know what the post-coronavirus economy holds, and we don’t know if there will be a second round … it depends on if there’s a vaccine.”

The hospital already has received a $1.5 million grant this year from the U.S. Department of Health and Human Services, and close to $1 million in donations for its emergency fund, which its foundation recently established with the goal to raise $2 million. It also is looking at holding off on $7.2 million in capital improvements to its facilities this year, including an upgrade at its Midvalley Medical Center in Basalt.

Because it is a quasi-government agency — the hospital has an elected board and is partly supported by a voter-approved mill levy property tax, for example — AVH did not qualify for enrollment in the Paycheck Protection Program offered by the Small Business Association, Sebenaler said.

“Our whole industry is going to be impacted for a long time as well as the local community,” Ressler told the board.

January and February boded well for the hospital’s financial picture, Sebenaler told the board, noting that outpatient revenue amounts to nearly $24 million compared with $6.5 million in in-patient revenue. Net patient revenue exceeded budget projections by 3.6% in February.

“Through February, we were $1.2 million better than budget,” she told the board. “This is important because I want to remind everyone that we were doing really well the first two months.”

The hospital hopes to recapture some of its lost business whenever operations return to normal, and its most recent forecast model has it hitting 90% of budget from July through December. The executive team plans to revisit those projections given the fluidity of the situation, they said.

May is one of AVH’s slowest months, Ressler said, and recent AVH projections have put that month’s daily revenue at $112,771, down from $315,254 it had originally forecast.

The hospital also had projected $418,540 in daily revenue for April, but readjusted that figure to $147,439.

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